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Inconceivable: The spiritual test of infertility

God said, "Be fruitful and multiply." But millions of couples can't do that on their own, and the spiritual struggles are often as daunting as the physical and emotional ones.

New parents often describe childbirth and their part in procreation in religious, almost mystical, terms. It's a "miracle," "awesome," "glorious." Giving birth to their children is why God put them on this earth, a vocation, more important than anything else they will ever do. Some even see it as sharing in God's creative power.

So what if you were told you could never have that?

"You do wonder why God is doing this to you," says Kristin Johnson, whose husband's infertility led a physician to tell the St. Louis couple it would take a "miracle" for them to get pregnant on their own. "You think it's going to be so easy, and then you wonder, ‘Why is this happening to me? What did we do wrong? Doesn't God want us to be parents?'?"

Infertility is a medical diagnosis (the inability to conceive after one year of trying or to carry a pregnancy to live birth), and one with serious psychological and emotional ramifications. It also can be, especially for Catholics and other people of faith, a spiritual crisis. Although the moral and ethical issues surrounding reproductive technology are part of it, the even larger questions involve one's image of God, vocation, prayer life, and ideas about God's role in a person's life.

The spiritual questions raised by infertility are affecting an increasing number of people, in part because many couples are trying to get pregnant later in life. More than 6 million American women age 15 to 33 suffer from infertility, roughly 10 percent of women of reproductive age. Yet infertility is not only a women's issue: one third of infertility problems are attributed to the male partner, and another third are related to both the man and woman.

Johnson, who asked that her real name not be used, had drifted from the church but returned to Mass during their infertility problems. "I think I was looking for answers," she says. The couple got a happy one: With the help of reproductive technology, including in vitro fertilization, Kristin became pregnant and is expecting in March. This, too, she sees as God's will, a blessing.

"We definitely think God answered our prayers," she says. And if it hadn't worked? "We were open to adoption, if that was what God wanted for us."

But saying "it was meant to be" when treatment is successful can be hard to hear for those who walk away with empty arms. "That's not particularly helpful to them," says Dianne Clapp, a psychiatric nurse and medical information director for Resolve, a national infertility support organization. "What people really need is support around the loss."

And infertility is a loss-not always of a specific child, although multiple miscarriages are common-but usually the less tangible, more difficult loss of a dream: the dream of an easy, unassisted conception; the dream of children who look like you or your relatives; the dream of having a "normal" family.

Infertility also often involves grief and loss on a spiritual level, as old images of God or ideas about how God works don't seem to fit anymore. "Anger at a supreme being is a normal thing as people wonder ‘Why me?'" says Clapp. "But I urge people to reframe it. Rather than searching for answers, I encourage people to pray to God for help in coping and navigating this the best they can."

Fertile faith

Mary and Sam Nelson of Denver married in their late 30s and spent six years trying to have a child. They tried everything: acupuncture, diet, drugs, prayer, and eventually in vitro fertilization. Not only was it ultimately unsuccessful, but it also was a difficult moral decision and cost tens of thousands of dollars.

"Every time we got a phone call from the doctor it was more bad news. It was heartbreaking," remembers Mary (not her real name). "My husband was all set on adoption, but I was having a hard time letting go of the dream."

For Nelson, the deepest grieving involved the genetic connection, as she loved seeing the family resemblance in her nieces and nephews. "It wasn't about the physical, but more about their personalities and how they're wired. I also wondered what a combination of my husband and me would be like," she says.

She eventually found peace by realizing that all children are God's children-a shift necessary for them to adopt their newborn twins. "I got this whole new way of thinking about it, that I'm more connected to humanity as a whole than to just this gene line, so what does it matter?" she says.

Nelson won't deny that she was sad and angry-but it was rarely directed at God. "My image of God isn't of a God doling out rewards and punishments," she says. "Instead, for whatever reason this was happening to us, and I was trying to understand what to learn from it."

One lesson was to let go. "It's hard because the medical side of infertility treatment is so planned and controlled," she says. "You think that if you just eat the right things or do acupuncture, you can control the situation."

She also let go of the need for answers. "There are a lot of things we don't have answers about," she says. "That brings us back to the mystery of our faith."

Accepting and living with mystery is necessary, even when the news eventually is good. Jane and Joe Cavanaugh of Minneapolis were told they had a 2 percent chance of getting pregnant on their own. They struggled with the morality of some infertility treatments and were turned off when their doctor pushed egg donation. Finally, with the help of Eastern medicine-such as acupuncture, yoga, and herbal treatments-they beat the odds.

"I do see our daughter as a gift from God, but I don't know why it happened to us," says Jane, a spiritual director. "I connect it to the power of prayer, because so many people were praying for us. But what about others who have that prayer behind them, too, and don't get pregnant? I was afraid it means that God isn't in charge."

Her husband, Joe, doesn't see God as waving a magic wand. "That's not a God I believe in," he says. "I do believe this is a miracle in the sense that God's love made it happen. But there's mystery involved. It's about the constant miracle of possibility and trying to be open to the wonderful possibilities God puts in front of you."

Jane calls it being open to the "yes/and": "One path is not always the right and only way," she says. "But when it's not the particular path we were expecting, it's OK to tell God how you're feeling. You have to keep God in the equation, even if you're sad and angry. God can take it."

Creation spirituality

"Maybe God doesn't want us to have any more kids." That's what Emily Holtel-Hoag of Cleveland initially thought when she and her husband, Mike, had difficulty conceiving when trying for their second child.

"But the more I thought about it, I realized I didn't really believe God is a micromanager," she says. "I don't think God causes infertility or miscarriages but I do believe God is present and brings grace to the challenges we have in our lives."

Like most people, Holtel-Hoag used to think of procreation in purely physical terms: she and her husband creating biological children, preferably unassisted by medical intervention. The desire to have children, especially after finding and committing to your partner, is a nearly universal human drive and one that many perceive as God-given.

That's natural, says Jeannie Hannemann, founder of Elizabeth Ministry, which connects women in parishes around issues of childbearing. "Our God is so much a God of creation," she says. "The first command God gives to humans is to ‘be fruitful and multiply.' So it's written deep in our hearts that we want to conceive. It's how God made us."

God doesn't desire for any couple to be infertile, she says. "But when we suffer from infertility, God is grieving with us," says Hannemann, who experienced infertility herself. "Yes, God wants us to procreate, but God can also bring good out of every situation. If you are suffering from infertility, God will have a plan for you out of all that pain."

In Holtel-Hoag's case a trusted mentor challenged her to think more expansively about other ways to bring life to the world. "That really clicked for me," she says. "Spiritual generativity is more about how we're going to co-create with God. It helped me see that as human beings we want to be procreators in some sense of the word."

She and her husband considered "creating" in other ways, such as helping a refugee family or becoming more involved in their parish and community. They eventually decided to adopt an infant from Guatemala.

"We realized we have a lot of love in us and a lot to offer," she says. "So if we're not going to be having more children, we have a responsibility to share that love and these gifts with the world in some way."

While an initial response to infertility might be to be angry at God or to question or reject one's faith, many infertile couples eventually turn to their faith for strength during such a difficult time in their marriage. Prayers range from "Dear God, please give us a baby" to "Not my will but yours be done."

Mary's words from the Annunciation-"Let it be done according to your will"-became Holtel-Hoag's prayer. "I was trying to open myself up to the possibilities and to God," she says. "Now I'd probably say, ‘Let it be done, with me, according to your will,' to show that it's a partnership between me and God."

The Prayer of St. Francis is helpful to 27-year-old Katie Malone of Baltimore, who has suffered from early miscarriages in her attempts to get pregnant. "The part about ‘seek not so much to be consoled as to console' spoke to me," she says. "I pray to be compassionate toward others and not just focus on this one bad thing that's happening to me."

She also tries to emphasize gratitude in her prayer life, thanking God for five things each night. "I try to focus on the things I have," she says. "It keeps things in perspective."

But that doesn't mean she hasn't struggled with what her inability to carry a pregnancy to term means. "I had a lot of spiritual questions, and I still do, after my two miscarriages. What was it? Was it a baby? Did it have a soul?" she says. "If it has a soul right after conception, then I feel guilty because I couldn't stay pregnant. But it's a hard question. I don't have the answers to that yet."

What she is sure of is that God is calling her to be a mother. "Of course, biological children are what I've always pictured myself having, but I'd be very excited about adoption," she says. "Maybe this is God's way of saying you have a lot to share and there's someone out there who needs a home. I feel we have so much and so much to be thankful for."

Birthing new life

Being able to experience new life-either literally through a successful pregnancy, through adoption or other ways of helping children, or through choosing to remain childless and instead focus on serving the wider community-after the "death" of infertility mirrors the Christian story of Resurrection and redemption. Although the pain is real, ultimately many couples find their faith helps them move through that grief and make life-giving choices for themselves and for others. While they wouldn't wish it on their worst enemy, some couples see their infertility journey as one that helped them grow into more compassionate, open people.

In the end, Holtel-Hoag ended up feeling grateful after her infertility struggle. "It seems to me that when you say ‘yes' to God's possibilities, God says ‘yes' back to you," she says, just home from her first visit to 3-month-old Isaiah in Guatemala, one of several trips before the adoption is final. "Once we did that, things just seemed to fall in place-not just the adoption but life in general."

Mary Nelson's gratitude and compassion are focused on her twins' birthmother, whom they got to know through an open adoption, and on others who suffer from infertility. "You really feel for other people who can't have children," she says. "So many people are going through this, but everyone tells me they feel so alone. I think I really grew in compassion."

The Cavanaughs are grateful for 6-month-old Tess but also for the spiritual insights gained through their experience of infertility. Jane says she not only learned to "trust her gut," but she also expanded her vision of God. "The most interesting thing was the surprise element of God," she says. "You can't figure God out. And I love that."

Heidi Schlumpf, a former editor at U.S. Catholic, is an associate professor of communications at Aurora University in Aurora, Illinois and author of While We Wait: Spiritual and Practice Advice for Those Trying to Adopt. See more posts by Heidi Schlumpf